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Sexual Dysfunction Due to a General Medical Condition
DSM-IV For more information, see Mental Disorders Due to a General Medical Condition Diagnostic Criteria A'''. Clinically significant sexual dysfunction that results in marked distress or interpersonal difficulty predominates in the clinical picture. '''B. There is evidence from the history, physical examination, or laboratory findings that the sexual dysfunction is fully explained by the direct physiological effects of a general medical condition. C'. The disturbance is not better accounted for by another mental disorder (e.g., Major Depressive Disorder). ''Specify predominant sexual dysfunction: * '''Female Hypoactive Sexual Desire Disorder Due to General Medical Condition: if deficient or absent sexual desire is the predominant feature * Male Hypoactive Sexual Desire Disorder Due to General Medical Condition: if deficient or absent sexual desire is the predominant feature * Male Erectile Disorder Due to General Medical Condition: if male erectile dysfunction is the predominant feature * Female Dyspareunia Due to General Medical Condition: if pain associated with intercourse is the predominant feature * Male Dyspareunia Due to General Medical Condition: if pain associated with intercourse is the predominant feature * Other Female Sexual Dysfunction Due to General Medical Condition: if some other feature is predominant (e.g., Orgasmic Disorder) or no feature predominates * Other Male Sexual Dysfunction Due to General Medical Condition: if some other feature is predominant (e.g., Orgasmic Disorder) or no feature predominates Note: Include the name of the general medical condition, e.g., Male Erectile Disorder Due to Diabetes Mellitus; also record the general medical condition. Subtypes The diagnostic term for a Sexual Dysfunction Due to a General Medical Condition is selected based on the predominant Sexual Dysfunction. The terms listed below should be used instead of the overall rubric "Sexual Dysfunction Due to a General Medical Condition." Female Hypoactive Sexual Desire Disorder Due to General Medical Condition This term is used if, in a female, deficient or absent sexual desire is the predominant feature. Male Hypoactive Sexual Desire Disorder Due to General Medical Condition This term is used if, in a male, deficient or absent sexual desire is the predominant feature. Male Erectile Disorder Due to General Medical Condition This term is used if male erectile dysfunction is the predominant feature. Female Dyspareunia Due to General Medical Condition This term is used if, in a female, pain associated with intercourse is the predominant feature. Male Dyspareunia Due to General Medical Condition This term is used if, in a male, pain associated with intercourse is the predominant feature. Other Female Sexual Dysfunction Due to General Medical Condition This term is used if, in a female, some other feature is predominant (e.g., Orgasmic Disorder) or no feature predominates. Other Male Sexual Dysfunction Due to General Medical Condition This term is used if, in a male, some other feature is predominant (e.g., Orgasmic Disorder) or no feature predominates. Recording Procedures In recording the diagnosis of Sexual Dysfunction Due to a General Medical Condition, the clinician should note both the specific phenomenology of the dysfunction (from the list above) and the identified general medical condition judged to be causing the dysfunction (e.g., Male Erectile Disorder Due to Diabetes Mellitus). The general medical condition is also noted (e.g., diabetes mellitus). Associated General Medical Conditions A variety of general medical conditions can cause sexual dysfunction, including neurological conditions (e.g., multiple sclerosis, spinal cord lesions, neuropathy, temporal lobe lesions), endocrine conditions (e.g., diabetes mellitus, hypothyroidism, hyper- and hypoadrenocorticism, hyperprolactinemia, hypogonadal states, pituitary dysfunction), vascular conditions, and genitourinary conditions (e.g., testicular disease, Peyronie's disease, urethral infections, postprostatectomy complications, genital injury or infection, atrophic vaginitis, infections of the vagina and external genitalia, postsurgical complications such as episiotomy scars, shortened vagina, cystitis, endometriosis, uterine prolapse, pelvic infections, neoplasms). Current clinical experience suggests that Sexual Dysfunction Due to a General Medical Condition is usually generalized. The associated physical examination findings, laboratory findings, and patterns of prevalence or onset reflect the etiological general medical condition. Differential Diagnosis Primary Sexual Dysfunctions Sexual Dysfunction Due to a General Medical Condition is diagnosed only if the sexual dysfunction is fully explained by the direct effects of a general medical condition. If psychological factors also play a role in the onset, severity, exacerbation, or maintenance of a sexual dysfunction, the diagnosis if the primary Sexual Dysfunction (with the subtype Due to Combined Factors). In determining whether the sexual dysfunction is primary or exclusively due to the direct effects of a general medical condition, a comprehensive psychosexual and medical history is the most important component of the evaluation. For males, tests such as nocturnal penile tumescence, vascular studies, and injection of tissue activators may be helpful in the assessment. Careful gynecological examination is important in making these determinations in women, especially in assessing Sexual Pain Disorders in females. Neurological evaluation and endocrine assessment may be helpful in both men and women. Substance-Induced Sexual Dysfunction If there is evidence of recent or prolonged substance use (including medications), withdrawal from a substance, or exposure to a toxin, and that the sexual dysfunction is fully explained by the direct effects of the substance, a Substance-Induced Sexual Dysfunction should be considered. The clinician should inquire carefully about the nature and extent of substance use, including medications. Symptoms that occur during or shortly after (i.e., within 4 weeks of) Substance Intoxication or after medication use may be especially indicative of a Substance-Induced Sexual Dysfunction, depending on the type or amount of the substance used or the duration of use. If the clinician has ascertained that the sexual dysfunction is due to both a general medical condition and substance use, both diagnoses (i.e., Sexual Dysfunction Due to a General Medical Condition and Substance-Induced Sexual Dysfunction) can be given. Major Depressive Disorder Hypoactive sexual desire, arousal dysfunction, and, to a lesser extent, orgasmic dysfunction can also occur as symptoms of Major Depressive Disorder. In Major Depressive Disorder, no specific and direct causative pathophysiological mechanisms associated with a general medical condition can be demonstrated. Aging Sexual Dysfunction Due to a General Medical Condition must be distinguished from the diminished sexual interest and functioning that may accompany aging. DSM-5 As of DSM-5, this diagnosis is no longer part of the DSM. For more information, see Sexual Dysfunctions